There has been substantial progress in reducing child mortality in the past several decades. Between 1990 and 2016, the global under-five mortality rate dropped by 56 percent from 93 deaths per 1,000 live births to 41 deaths per 1,000 live births. Over the last sixteen years, the reduction in child mortality rates accelerated, compared to the previous decade. As a consequence, around 50 million more young children survived the first five years of life since 2000 who would have died had under-five mortality remained at the same level as in 2000.

But even in 2016, 15,000 children died every day (totaling 5.6 million a year). While a substantial reduction from the 35,000 deaths a day in 1990 (12.6 million a year), more needs to be done to meet target 3.2 of the Sustainable Development Goals, which aims for all countries fewer than 25 deaths of under-5s per 1,000 live births.

Large disparities in child survival rates exist across regions and countries. Sub-Saharan Africa has the highest under-five mortality rate - in 2016 it was 78 deaths per 1,000 live births in that region, where approximately 1 child in 13 dies before his or her fifth birthday. This compares sharply with high-income countries where the under-five mortality rate is 5 per 1,000 live births - just 1 child in 200 dies at this early age.

More than 80 percent of global under-five deaths occur in just two regions – Sub-Saharan Africa and South Asia. By country, Somalia has the highest under-five mortality at 133 per 1,000 (1 in 8 children dies) while Finland, Iceland, Luxemburg and Slovenia have the lowest ratio at 2 per 1,000 (1 child death per 500 live births).

The UN IGME reports that most under-five deaths are caused by diseases that are readily preventable or treatable with proven, cost-effective interventions. Infectious diseases and neonatal complications are responsible for the vast majority of global under-five deaths. More lives can be saved by concentrating interventions in those regions and areas reporting high child mortality rates.

Slower progress in reducing neonatal mortality

Risk of dying among children is highest in their first month of life where nearly half (46 percent) of under-five deaths occur during this neonatal period. Progress is slower in reducing neonatal mortality rates than in reducing under-five mortality rates. The neonatal mortality rate fell by 49 percent from 37 deaths per 1,000 live births in 1990 to 19 in 2016, still some way off the SDG target of neonatal mortality being as low as 12 per 1,000 live births. Thus, the proportion of under-five deaths in the neonatal period has increased from 41 percent to 46 percent between 1990 and 2016.

Sub-Saharan Africa and South Asia each accounted for 39 percent of all global neonatal deaths. In the former an increase in the number of births and the slow decline in the neonatal mortality rate has resulted in the number of neonates dying each year stagnating at around 1 million since 1990. Across countries, neonatal mortality rates ranged from 46 deaths per 1,000 live births in Pakistan to 1 per 1,000 in Iceland, Japan and San Marino. Five countries accounted for half of the global 2.6 million neonatal deaths in 2016: India (24 percent), Pakistan (10 percent), Nigeria (9 percent), the Democratic Republic of the Congo (4 percent) and Ethiopia (3 percent).

The press release notes that if the current trend continues, 30 million children will die in the neonatal period between 2017 and 2030. The World Bank’s World Development Indicators database shows nearly half of all births in Sub-Saharan Africa and a quarter of all births in South Asia were not attended by skilled health staff. Improving access to equipped skilled health staff at the time of birth and the postpartum period will save lives of newborns as well as their mothers.

For the first time, mortality data for children ages 5-14 was included in the UN IGME report. The risk of dying for this age group is substantially lower than among younger children. However, about one million children in this age group died in 2016, reduced from 1.7 million in 1990. Large disparities also exist across regions and countries. In Sub-Saharan Africa, 18 out of 1000 children die in this age group and 7 out of 1000 in South Asia, whereas in high-income countries the ratio is just 1 out of 1000.

As I wrote in my earlier blog on child mortality, the UN’s Millennium Development Goals have brought statisticians together to produce better data to monitor progress. The UN Inter-agency Group for Child Mortality Estimation (UN IGME) was formed in 2004 to share data in child mortality, harmonize estimates within the UN system, improve methods for child mortality estimation, and to report on progress towards the original Millennium Development Goals. The UN IGME includes UNICEF, the World Health Organization, the World Bank Group and the United Nations Population Division as full members, and it continues to produce reliable and transparent child mortality estimates in order to track countries’ progress towards SDG target 3.2. All data, estimates and details on UN IGME methods are available on the Child Mortality Estimates (CME INFO) website at childmortality.org. The new UN IGME child mortality estimates are also available in the World Bank’s World Development Indicators and HealthStats databases.

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